1. Field of the Invention
The present invention relates to a gas/saline insufflation system for distending a knee joint, a shoulder joint, an elbow joint, an ankle joint or a wrist and more particularly to a gas/saline valve with suction control which a surgeon uses to efficiently change between a saline environment and a gas environment during diagnostic arthroscopy and laser arthroscopic surgery.
2. Description of the Prior Art
In their article, entitled "Laser Energy in Arthroscopic Meniscectomy," published in Orthopedics, Volume 6, Number 9, pages 1165-1169, September, 1983, Terry L. Whipple, Richard B. Caspari and John F. Meyers discussed the rationale and technique for performing arthroscopic meniscectomy with a carbon dioxide laser system. They distended the knee joint with either nitrogen or carbon dioxide through the sleeve of the arthroscope via a gas infusion pump, which maintained the intra-articular pressure in the range of 80 to 100 mm Hg. Before they introduced the laser cannula through a separate portal, they switched the gas infusion to the laser cannula in order to prevent liquid or particulates from entering the laser cannula.
U.S. Pat. No. 4,369,768, entitled Arthroscope, issued to Marko Vukovic on Jan. 25, 1983, teaches an arthroscope. U.S. Pat. No. 3,769,962, entitled Barium Enema Administration Method and Apparatus, issued to Raymond McVey on Nov. 6, 1973, teaches a barium enema administration apparatus which includes a first conduit, a second conduit and a third conduit all are connected together at three-way union. The first conduit is connected to a gravity fed barium supply source. The second conduit is connected with a source of air under pressure. The third conduit is an evacuation line which is connected to a source of suction. Each conduit is controlled by an individual valve. The valves are opened and closed in a prescribed sequence as directed by a radiologist.
On July 29, 1986 Chadwick F. Smith and Leroy V. Sutter, Jr. filed an application, entitled Arthroscopic Attachment for Use with a Laser System, having Ser. No. 891,224, described an arthroscopic attachment. A laser system is optically and mechanically coupled to the arthroscopic attachment so that the arthroscopic attachment may be used surgically under arthroscopic control. The arthroscopic attachment includes a gas inlet for letting a gas into the arthroscopic attachment and a lens focusing system for focusing the beam of light energy into a guide member which also functions as a gas nozzle.
In their article, entitled "The Use of Laser Beams for Operations in Haemophilia," published in The Scandinavian Journal of Haemotology in 1984, Supplementum 40, Volume 33, pages 281-289, 1984 F. Hefti, E. Morscher and F. Koller used a Sharplan 791 CO2 Surgical Laser to perform five synovectomies of the knee joint, four synovectomies of the elbow joint and one splitting of the retinaculum of the knee joint.
U.S. Pat. No. 3,865,113, entitled Laser Device Particularly Useful as Surgical Scalpel, issued to Uzi Sharon and Isaac Kaplan on Feb. 11, 1975, teaches a laser beam manipulator including a tube which is optically coupled through an articulated arm to a carbon dioxide laser system and a beam targeting member which is carried by the tube.
U.S. Pat. No. 3,710,798, entitled Laser System for Microsurgery, issued to Herbert C. Bredemeier on Jan. 16, 1973, teaches a laser system for microsurgery which includes a mirror for changing the direction of a beam of light energy from a carbon dioxide laser system and directing the beam to the treatment site.
U.S. Pat. No. 3,982,541, entitled Eye Surgical Instrument, issued to Francis A. L'Esperance on Sept. 28, 1976, teaches a method of surgically removing body tissue which includes the steps of contacting the body tissue with a probe open at a free end, passing a carbon dioxide laser beam through a central passage in the probe and the open end to the tissue at a power level sufficent to affect vaporization of tissue, vaporizing only the surface portion of the tissue exposed to the carbon dioxide laser beam in a manner so that the vaporizing step is surface phenomena at a depth not more than about 0.33 millimeters, introducing a gas stream into the probe downstream from the lenses associated with the carbon dioxide laser beam, passing the gas stream through the probe in a direction towards its free end and out thereof, and removing smoke and any vaporized portion of the tissue through the probe by way of the gas stream.
U.S. Pat. No. 3,982,533, entitled Insufflation Apparatus, issued to F. M. Wiest on Sept. 28, 1976, teaches an apparatus for introducing limited quantities of carbon dioxide into the human body for operational purposes, particularly laparoscopy. The insufflation apparatus includes a control device for delivering the carbon dioxide, a connecting nipple on the control device for connecting a first flexible tubing to a first operative cannula of a dual Veress needle introducable into the body and a pressure gauge for indicating the pressure present in the body cavity. The insufflation apparatus also includes a second connection nipple which is disposed on the control device and which is connected by a nipple to a pressure gauge. The second connection nipple is connected by a second flexible tubing to a second coaxial cannula of the dual Veress needle so that the pressure gauge is directly connected with the body cavity rather through the first cannula of the dual Veress needle.
U.S. Pat. No. 4,048,992, entitled Insufflator, issued to Hans-Joachin Lindemann and F. M. Wiest on Sept. 20, 1977, teaches an apparatus for introducing limited quantities of carbon dioxide into the human body for operational purposes, particularly laparoscopy or hysteroscopy. The insufflation apparatus includes two pressure reducers, in series, followed by a gas flow monitoring device through which carbon dioxide is directed from a gas supply to a human body. The two pressure reducers are constantly adjusted to fixed gas supply pressures. The gas flow monitoring device includes a cylindrical expansion container which has a central inlet port and a large diameter, and in whose peripheral zone the gas flow velocity approaches a zero rate. First and second sensing elements for the measured variable are provided in the expansion container. The first sensing element is located immediately in the area of the inlet port and the second sensing element is located close to the cylindrical side wall at the maximum possible radial spacing from the first sensing element. The two sensing elements are included in a measuring bridge and a measuring amplifier is connected to the bridge output. An indicator of the rate of flow is connected to the amplifier output. The second pressure reducer may be adjusted to a supply pressure in the range of 15 to 200 mm Hg.
U.S. Pat. No. 3,709,214, entitled Gas Obturating Method, issued to Jack R. Robertson on Jan. 9, 1973, teaches a method of diagnosis and/or therapy of an internal part of the body which is accessible from an adjacent body opening. The method includes the step of introducing a gas under pressure into the adjacent body opening.
U.S. Pat. No. 4,550,240, entitled Laser Irradiating Apparatus, issued to Masahiro Toida and Norihiro Suenaga and Nobuyuki Suenaga on Oct. 29, 1985, teaches a laser irradiating apparatus which includes first and second light guides for two laser beams at a first wavelength and a second wavelength, respectively, and first and second supply for a first assist gas and a second assist gas, respectively.
U.S. Pat. No. 4,207,887, entitled Gas Insufflation Apparatus, issued to Siegfried Hiltebrandt and Helmut Wurster on July 17, 1980, teaches a gas insufflation apparatus which introduces limited quantities of carbon dioxide into a body cavity for operational purposes, particularly laparoscopy or hysteroscopy. The gas insufflation apparatus includes a compressed gas cylinder containing carbon dioxide, the pressure of which is controlled and monitored by a first pressure gauge and a first pressure regulator in series. From the first pressure regulator the gas flows at reduced pressure via a shut-off valve to an intermediate container the pressure and quantity of gas in which can be read off a second pressure gauge. The container also has a safety valve. The reduced-pressure insufflation gas from the container flows through a second pressure regulator which is advantageously continuously adjustable and by means of which the desired gas pressure in a body cavity required by a particular patient can be preselected. The regulated pressure can be monitored by a third pressure gauge. To inject a volume of gas into the body cavity, a valve downstream of the second pressure regulator is opened manually so that the gas will then flow to the body cavity via a rate of flow controller, an insufflation duct and a tube constituted by the cannula. The preselected pressure is maintained by the second pressure regulator.
U.S. Pat. No. 3,885,590, entitled Gas Transmission and Monitoring Device, entitled to John L. Ford on May 27, 1975, teaches a compact self-contained flow and pressure regulator device which transmits and monitors gas from a source of compressed gas to a body cavity during surgery. The device includes a selectively adjustable pressure regulator which controls the gas received from the compressed gas source, a limiting orifice to attenuate the flow rate and an off-on valve. The device also includes an adjustable pressure valve which controls the discharge gas pressure, a gauge which indicates the discharge gas pressure, and a safety relief valve.
On Dec. 15, 1986 Leroy V. Sutter, Jr. and Chadwick F. Smith filed an application, Ser. No. 941,165, entitled Self-Cleaning Suction Probe for Arthroscopic Surgery, which teaches a self-cleaning suction probe. The surgeon doing arthroscopic surgery uses the self-cleaning suction probe in an irrigation system in order to provide egress for saline and body fluid from an irrigation site.
U.S. Pat. No. 4,487,600, entitled Adjustable Suction Device for Medical Use, issued to Alan W. Brownlie and Roger D. Spier on Dec. 11, 1984, teaches an adjustable, disposable suction device which is particularly adapted for medical use. A surgeon uses the adjustable suction device to remove either excess blood or body fluids from an open incision during surgery.
U.S. Pat. No. 4,604,089, entitled Pressure Regulated Irrigation System for Arthroscopy, issued to John A. Santangelo and Charles B. Worrick on Aug. 5, 1986, teaches a pressure regulated system irrigation system which includes a reservoir of irrigation fluid, such as saline, a pump and catheters which provide access to and egress from the irrigation site.